Anisa poignantly wrote:

> Was I depressed after the birth?  you'd better believe it.  Some of this
> was
> adjustment disorder, pure and simple; some of it was hormonal, some of it
> was a predisposition toward depression. a LOT of it was that I felt like a
> failure because things didn't go the way they were "supposed" to go in some
> idealized sense, which had a lot to do with the expectations I set for
> myself. This depression was set up to some extent by many of the things I
> read that presented natural birth as entirely normative and anything less as
> a failure.
>
This is a crucial aspect that has not been mentioned in the discussion until
now.  There is ample evidence that depression can impede attachment and
bonding.  It gets in the way of normal daily tasks, including breastfeeding.  To
make matters worse, depressed mothers *need* to breastfeed more than other
mothers to stabilize mood and to assist with mothering abilities which are
threatened by the depression.  Yet these mothers are often told to wean or are
otherwise unable to gather support and assistance with breastfeeding.  Not
breastfeeding creates a pathological hormonal experience for mothers.

We know that Oxytocin release is an important part of labor and birthing.
While its function is not fully understood in all of its complexity, I like to
refer to it as the crucial hormone of mothering.  When C/S are scheduled--as
seems to be the more common experience--, she loses the spontaneous release of
oxytocin in labor.  Epidurals are known to inhibit oxytocin release.  A final,
powerful release occurs when the baby's head creates transvaginal pressure.
This is absent by definition with a C-Sec. I don't know that we give hormones
their due, but I have to believe that they have an important function or they
wouldn't be there.  Perhaps these seemingly insignificant hormonal absences are
but one of the many components that account for delayed lactogenesis in many
mothers after a C/s.  Even less serious breastfeeding difficulties on top of
birth disappointment, history of depression, lack of familial support may be
more than this mother can cope with, absent the normal endocrinological
experience.

I hope that those of us who teach are able to present honest and complete
information in a way that lessens feelings of failure when the outcome isn't as
planned, whether we are teaching about birth, breastfeeding, or other important
life experiences.  I hope that we are able to grieve with mothers who are
saddened by their experiences, just as we celebrate with those who are happy.

Nancy Williams, MA, MFT, IBCLC, CCE

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